| Wallace Urgent Care LLC | |
|
112 Medical Village Dr Unit F Wallace NC 28466-9999 | |
| (910) 552-1580 | |
| (910) 665-1780 |
| Full Name | Wallace Urgent Care LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 112 Medical Village Dr, Wallace, North Carolina |
| Authorized Official Name and Position | Kamran Goudarzi (OWNER) |
| Authorized Official Contact | 9105521580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wallace Urgent Care LLC 112 Medical Village Dr Unit F Wallace NC 28466-9999 Ph: (910) 552-1580 | Wallace Urgent Care LLC 112 Medical Village Dr Unit F Wallace NC 28466-9999 Ph: (910) 552-1580 |
| NPI Number | 1841259025 |
|---|---|
| Provider Enumeration Date | 03/17/2006 |
| Last Update Date | 06/24/2025 |
| Certification Date | 06/24/2025 |
| Medicare PECOS PAC ID | 6709967912 |
|---|---|
| Medicare Enrollment ID | O20080222000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841259025 | NPI | - | NPPES |
| 01736 | Other | NC | NCBCBS PROVIDER NUMBER |
| 7901736 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 363A00000X | Physician Assistant | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Secondary |
| Provider Name | Michael T Lewis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639150824 PECOS PAC ID: 3577532118 Enrollment ID: I20040929001195 |
| Provider Name | Daniel M Ricci |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528067519 PECOS PAC ID: 3971415415 Enrollment ID: I20050714000968 |
| Provider Name | Jeffrey W Autry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063474559 PECOS PAC ID: 9537253208 Enrollment ID: I20070926000274 |
| Provider Name | Michael Henry Cartledge |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073586590 PECOS PAC ID: 2163517731 Enrollment ID: I20070927000884 |
| Provider Name | Maryanna Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720541220 PECOS PAC ID: 5395078869 Enrollment ID: I20190615000203 |
| Provider Name | Jeffrey Lance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902281132 PECOS PAC ID: 5597065516 Enrollment ID: I20200510000096 |
| Provider Name | Samuel H Weatherford |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508075896 PECOS PAC ID: 2961815089 Enrollment ID: I20210111001511 |
| Provider Name | Jennifer Nicole Brennan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730804907 PECOS PAC ID: 5698145399 Enrollment ID: I20221221000215 |
| Provider Name | Yvonne Dao |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982281531 PECOS PAC ID: 6507275252 Enrollment ID: I20240314002179 |
| Provider Name | Heather J Van Marion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598590374 PECOS PAC ID: 2365975893 Enrollment ID: I20250627002812 |
Wallace Urgent Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Medical Village Dr, Ste G, Wallace, NC 28466 Phone: 910-285-0333 |
House of Raeford Health & Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Medical Village Dr Ste F, Wallace, NC 28466 Phone: 910-285-0940 Fax: 910-285-1825 |
Blair Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 E Main St, Wallace, NC 28466 Phone: 910-285-3380 |
Daniel M Ricci M.D. P.A. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 207 E Murphy St, Wallace, NC 28466 Phone: 910-285-4100 Fax: 910-285-4766 |
Po Powell Management Group, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Medical Village Dr Ste F, Wallace, NC 28466 Phone: 910-665-1780 Fax: 910-665-1780 |
Trinity Family Medicine, P.A. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Medical Village Dr, Unit D, Wallace, NC 28466 Phone: 910-285-7592 Fax: 910-285-4610 |